Negative impact of a 1-month period of night shifts on mental and physical health among Swiss internal medicine residents

STUDY

Aims

To assess the impact of short periods of night shifts on: sleep quality and sleep medication intake, burnout scores, care-related regrets experience and coping mechanisms of internal medicine residents.

Methods

Before-after analysis of data from the Nightshift project, a repeated measures evaluation of the clinical activity and burden of night shifts, conducted between October 2019 and March 2020 in the Division of General Internal Medicine of Geneva University Hospitals (Clinicaltrials.gov: NCT04123015). Forty-one residents of 55 (74.5%) screened for eligibility were included before their first night shift. They completed an anonymous e-survey before and after a 1-month period of night shifts, assessing sleep quality, sleep medication intake, burnout scores using the Copenhagen Burnout Inventory (CBI), the number and intensity of care-related regrets using the Regret Intensity Scale (RIS-10) and resident’s coping abilities with the Care-related Regret Coping Scale for Health-care Professionals (RCS-HCP).

Results

After the 1-month period of night shifts, sleep medication intake had increased from 7.3% to 24.4%, p = 0.02. At baseline, 31 (75.6%) of the 41 participating residents (65.9% women) scored low in all three dimensions of burnout. For each burnout dimension, at least 30% of residents had an increase in score ≥5 points. Moderate or high levels of burnout remained stable for professional burnout (24.4%), but increased for personal (17.1% to 26.9%) and patient-related burnout (4.8% to 14.6%) though none of these changes were statistically significant. All of the 25% of residents who experienced regrets on actions taken during their shift were women. They reported overall limited coping abilities, e.g. 80% displayed frequent use of negative maladaptive strategies to deal with regret.

Conclusions

Even short periods of night shifts can have a significant impact on residents’ mental and physical health. A high proportion of residents had increased burnout scores, a factor known to be correlated with job dissatisfaction and absence due to sickness. Sleep medication intake increased 3-fold, suggesting sleep issues. Respondents reported frequent care-related regrets and poor coping abilities, with use of maladaptive strategies, known to be associated with poor sleep and job resignation. As stricter regulations on daily working hours are proposed, the frequency of on-call duties will inevitably increase. Understanding the implications of short periods of night shifts is not only essential for shaping residency programme policies and for shift scheduling, but also for informing training programmes on non-pharmacological sleep management, burnout prevention and the development of positive regret-coping strategies.